MEDICARE: MRS. TAMI LEIGH NEWBERN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	ARNP 9237911	FL

General Provider Information

NPI Number	:	1871888073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMI LEIGH NEWBERN ARNP

Provider Business Mailing Address
First Line	:	1631 RACE TRACK RD STE 101
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 RACE TRACK RD STE 101
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3233
Country	:	US
Telephone Number	:	904-230-7977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	07/25/2012

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